Amended in Senate April 7, 2015

Senate BillNo. 118


Introduced by Senator Liu

January 14, 2015


An act to amend Sections 124174, 124174.2, and 124174.6 of the Health and Safety Code, and to amend Section 1 of Chapter 381 of the Statutes of 2008, relating to public health.

LEGISLATIVE COUNSEL’S DIGEST

SB 118, as amended, Liu. School-Based Health and Education Partnership Program.

Existing law requires the State Department of Public Health, in cooperation with the State Department of Education, to establish a Public School Health Center Support Program to assist health centers in schools and school districts. Existing law establishes a grant program within the Public School Health Center Support Program to provide technical assistance, and funding for the expansion, renovation, and retrofitting of existing school health centers and the development of new school health centers. These provisions also provide funding for sustainability grants in amounts between $25,000 and $125,000.begin insert Existing law authorizes school health centers to provide physical, mental, and oral health assessments, screenings, and services.end insert

This bill would rename the program the School-Based Health and Education Partnership Program. The bill would instead provide funding for the expansion and renovation of existing school health centers. The bill would change the amount of the sustainability grants that are available pursuant to the program to between $50,000 and $100,000, but would make those grants available on a one-time basis and would revise the purposes for which they may be used. The bill would also authorize population health grants in amounts between $50,000 and $125,000 for a funding period of up to 3 years, as specified.begin insert The bill would authorize school health centers to provide alcohol and substance abuse assessments, screening, and services.end insert

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

P2    1

SECTION 1.  

Section 124174 of the Health and Safety Code
2 is amended to read:

3

124174.  

The following definitions govern the construction of
4this article, unless the context requires otherwise:

5(a) “Program” means the School-Based Health and Education
6Partnership Program.

7(b) “School health center” means a center or program, located
8at or near a local educational agency, that provides age-appropriate
9health care services at the program site or through referrals. A
10school health center may conduct routinebegin delete physical, mental health,end delete
11begin insert physical health, mental health, alcohol and substance abuse,end insert and
12oral health assessments, and provide referrals for any services not
13offered onsite. A school health center may serve two or more
14nonadjacent schools or local educational agencies.

15(c) For purposes of this section, “local educational agency”
16means a school, school district, charter school, or county office of
17education if the county office of education serves students in
18kindergarten, or any grades from 1 to 12, inclusive.

19(d) “Department” means the State Department of Public Health.

20

SEC. 2.  

Section 124174.2 of the Health and Safety Code is
21amended to read:

22

124174.2.  

(a) The department, in cooperation with the State
23Department of Education, shall establish the School-Based Health
24and Education Partnership Program.

25(b) The program, in collaboration with the State Department of
26Education, shall perform the following program functions:

27(1) Provide technical assistance to school health centers on
28effective outreach and enrollment strategies to identify children
29who are eligible for, but not enrolled in, the Medi-Cal program,
30Covered California, or any other applicable health insurance
31affordability program for children.

P3    1(2) Serve as a liaison between organizations within the
2department, including, but not limited to, prevention services,
3primary care, and family health.

4(3) Serve as a liaison between other state entities, as appropriate,
5including, but not limited to, the State Department of Health Care
6Services, the Department of Managed Health Care, and the Office
7of Emergency Services.

8(4) Provide technical assistance to facilitate and encourage the
9establishment, retention, or expansion of, school health centers.
10For purposes of this paragraph, technical assistance may include,
11but is not limited to, identifying available public and private
12sources of funding, which may include federal Medicaid funds,
13funds from third-party reimbursements, and available federal or
14foundation grant moneys.

15(c) The department shall consult with interested parties and
16appropriate stakeholders, including the California School-Based
17Health Alliance and representatives of youth and parents, in
18carrying out its responsibilities under this article.

19

SEC. 3.  

Section 124174.6 of the Health and Safety Code is
20amended to read:

21

124174.6.  

The department shall establish a grant program
22within the School-Based Health and Education Partnership Program
23to provide technical assistance, funding for the expansion and
24renovation of existing school health centers, and the development
25of new school health centers, in accordance with the following
26procedures and requirements:

27(a) A school health center receiving grant funds pursuant to this
28section shall meet or have a plan to meet the following
29requirements:

30(1) Strive to provide a comprehensive set of services including
31medical, oral health, mental health, alcohol and substance abuse,
32 health education, and related services in response to community
33needs.

34(2) Provide primary and other health care services, provided or
35supervised by a licensed professional, which may include all of
36the following:

37(A) Physical examinations, immunizations, and other preventive
38medical services.

39(B) Diagnosis and treatment of minor injuries and acute medical
40conditions.

P4    1(C) Management of chronic medical conditions.

2(D) Basic laboratory tests.

3(E) Referrals to and followup for specialty care.

4(F) Reproductive health services.

5(G) Nutrition services.

6(H) Mental healthbegin insert and alcohol and substance abuseend insert services
7provided or supervised by an appropriately licensed mental health
8begin insert or alcohol and substance abuseend insert professional may include:
9assessments, crisis intervention, counseling, treatment, and referral
10to a continuum of services including emergency psychiatric care,
11evidence-based mental healthbegin insert or alcohol and substance abuseend insert
12 treatment services, community support programs, inpatient care,
13and outpatient programs. School health centers providing mental
14healthbegin insert and alcohol and substance abuseend insert services as specified in
15this section shall consult with the local countybegin delete mentalend deletebegin insert behavioralend insert
16 health department for collaboration in planning and service
17delivery.

18(I) Oral health services that may include preventive services,
19basic restorative services, and referral to specialty services.

20(3)  Strive to address the population health of the entire school
21campus by focusing on prevention services, such as group and
22classroom education, schoolwide prevention programs, and
23community outreach strategies.

24(4) Strive to provide integrated and individualized support for
25students and families and to act as a partner with the student or
26family to ensure that health, social, or behavioral challenges are
27addressed.

28(5) Work in partnership with the school nurse, if one is employed
29by the local educational agency, to provide individual and family
30health education; school or districtwide health promotion; first aid
31and administration of medications; facilitation of student
32enrollment in health insurance programs; screening of students to
33identify the need forbegin delete physical, mental health,end deletebegin insert physical health,
34mental health, alcohol and substance abuse,end insert
and oral health
35services; referral and linkage to services not offered onsite; public
36health and disease surveillance; and emergency response
37procedures. A school health center may receive grant funding
38pursuant to this section if the local educational agency does not
39employ a school nurse. However, it is not the intent of the
P5    1Legislature that a school health center serve as a substitute for a
2school nurse employed by a local educational agency.

3(6) Have a written contract or memorandum of understanding
4between the local educational agency and the health care provider
5or any other community providers that ensures coordination of
6services, ensures confidentiality and privacy of health information
7consistent with applicable federal and state laws, and integration
8of services into the school environment.

9(7) Serve all registered students in the school regardless of
10ability to pay.

11(8) Be open during all normal school hours, or on a more limited
12basis if resources are not available, or on a more expansive basis
13if dictated by community needs and resources are available.

14(9) Establish protocols for referring students to outside services
15when the school health center is closed.

16(10) Facilitate transportation between the school and the health
17center if the health center is not located on local educational agency
18property.

19(b) Planning grants shall be available in amounts between
20twenty-five thousand dollars ($25,000) and fifty thousand dollars
21($50,000) for a 6- to 12-month period to be used for the costs
22associated with assessing the need for a school health center in a
23particular community or area, and developing the partnerships
24necessary for the operation of a school health center in that
25community or area. Applicants for planning grants shall be required
26to have a letter of interest from a local educational agency if the
27applicant is not a local educational agency. Grantees provided
28funding pursuant to this subdivision shall be required to do all of
29the following:

30(1) Seek input from students, parents, school nurses, school
31staff and administration, local health providers and, if applicable,
32special population groups on community health needs, barriers to
33health care, and the need for a school health center.

34(2) Collect data on the school and community to estimate the
35percentage of students that lack health insurance and the percentage
36that are eligible for Medi-Cal benefits, or other public programs
37providing free or low-cost health services.

38(3) Assess capacity and interest among health care providers in
39the community to provide services in a school health center. 

P6    1(4) Assess the need for specific cultural or linguistic services
2or both.

3(c) Facilities and startup grants shall be available in amounts
4between twenty thousand dollars ($20,000) and two hundred fifty
5thousand dollars ($250,000) per year for a three-year period for
6the purpose of establishing a school health center, with the potential
7addition of one hundred thousand dollars ($100,000) in the first
8year for facilities construction, purchase, or renovation. Grant
9funds may be used to cover a portion or all of the costs associated
10with designing, retrofitting, renovating, constructing, or buying a
11facility, for medical equipment and supplies for a school health
12center, or for personnel costs at a school health center. Preference
13will be given to proposals that include a plan for cost sharing
14among schools, health providers, and community organizations
15for facilities construction and renovation costs. Applicants for
16facilities and startup grants offered pursuant to this subdivision
17shall be required to meet the following criteria:

18(1) Have completed a community assessment determining the
19need for a school health center.

20(2) Have a contract or memorandum of understanding between
21the local educational agency and the health care provider, if other
22than the local educational agency, and any other provider agencies
23describing the relationship between the local educational agency
24and the school health center.

25(3) Have a mechanism, described in writing, to coordinate
26services to individual students among school and school health
27center staff while maintaining confidentiality and privacy of health
28information consistent with applicable state and federal laws.

29(4) Have a written description of how the school health center
30will participate in the following:

31(A) School and districtwide health promotion, coordinated
32school health, health education in the classroom or on campus,
33program/activities that address nutrition, fitness, or other important
34public health issues, or promotion of policies that create a healthy
35school environment.

36(B) Outreach and enrollment of students in health insurance
37programs.

38(C) Public health prevention, surveillance, and emergency
39response for the school population.

P7    1(5) Have the ability to provide the linguistic or cultural services
2needed by the community. If the school health center is not yet
3able to provide these services due to resource limitations, the school
4health center shall engage in an ongoing assessment of its capacity
5to provide these services.

6(6) Have a plan for maximizing available third-party
7reimbursement revenue streams.

8(d) Sustainability grants shall be available on a one-time basis
9in amounts between fifty thousand dollars ($50,000) and one
10hundred thousand dollars ($100,000) for the purpose of developing
11new and leveraging existing funding streams to support a
12sustainable funding model for school health centers. Examples of
13existing funding streams include local educational agency funds
14available under the local control funding formula, the federal
15Patient Protection and Affordable Care Act (Public Law 111-148),
16or the Mental Health Services Act. Applicants for sustainability
17grants offered pursuant to this subdivision shall be required to
18meet all of the criteria described in subdivision (c), in addition to
19both of the following criteria:

20(1) The applicant shall be eligible to become or already be an
21approved Medi-Cal provider.

22(2) The applicant shall have the ability and procedures in place
23for billing public insurance programs and managed care providers.

24(3) The applicant shall seek reimbursement and have procedures
25in place for billing public and private insurance that covers students
26at the school health center.

27(e) Population health grants shall be available in amounts
28between fifty thousand dollars ($50,000) and one hundred
29twenty-five thousand dollars ($125,000) for a funding period of
30up to three years to fund interventions to implement population
31health outcomes and target specific health or education risk factors
32including, but not limited to, obesity prevention programs, asthma
33prevention programs, early intervention for mental health, and
34alcohol and substance abuse prevention. Applicants for population
35health grants offered pursuant to this subdivision shall be required
36to meet all of the criteria described in subdivision (c).

37(f) The department shall award technical assistance grants
38through a competitive bidding process to qualified contractors to
39support grantees receiving grants under subdivisions (b), (c), (d),
40and (e). A qualified contractor means a vendor with demonstrated
P8    1capacity in all aspects of planning, facilities development, startup,
2and operation of a school health center.

3(g) The department shall also develop a request for proposal
4(RFP) process for collecting information on applicants, and
5determining which proposals shall receive grant funding. The
6department shall give preference for grant funding to the following
7schools:

8(1) Schools in areas designated as federally medically
9underserved areas or in areas with medically underserved
10populations.

11(2) Schools with a high percentage of low-income and uninsured
12children and youth.

13(3) Schools with large numbers of limited English proficient
14(LEP) students.

15(4) Schools in areas with a shortage of health professionals.

16(5) Low-performing schools with Academic Performance Index
17(API) rankings in the deciles of three and below of the state.

18(h) Moneys shall be allocated to the department annually for
19evaluation to be conducted by an outside evaluator that is selected
20through a competitive bidding process. The evaluation shall
21document the number of grantees that establish and sustain school
22health centers and describe the challenges and lessons learned in
23creating successful school health centers. The evaluator shall use
24data collected pursuant to Section 124174.3, if it is available, and
25work in collaboration with the School-Based Health and Education
26Partnership Program. The department shall post the evaluation on
27its Internet Web site.

28(i) This section shall be implemented only to the extent that
29funds are appropriated to the department in the annual Budget Act
30or other statute for implementation of this article.

31

SEC. 4.  

Section 1 of Chapter 381 of the Statutes of 2008 is
32amended to read:

33

Section 1.  

The Legislature finds and declares all of the
34following:

35(a) (1) School health centers provide quality, age and
36developmentally appropriate primary health care and other support
37services on or near a public school campus.

38(2) School health centers are primarily located in areas where
39children are underserved, lack health insurance, and face significant
40barriers to care.

P9    1(3) School health centers provide an optimal setting to promote
2healthy lifestyles such as good nutrition and fitness and provide
3preventive health care services such as obesity prevention to
4children and families.

5(4) School health centers increase access to care, reduce health
6disparities and provide potential savings through better preventive
7care and reduced emergency department utilization, drug
8utilization, and inpatient treatment services.

9(5) Children do better in school if they are healthy and have
10received all of their immunizations and preventive annual exams.

11(6) School health centers can be integral to providing the entire
12school community with prevention and health integration services
13by working collaboratively with school staff and administrators
14to meet the spectrum of health and prevention needs in a school
15community.

16(7) School health centers have proven to be particularly
17important to the Latino population, with recent estimates showing
18that approximately 49 percent of youth served at high school health
19centers and 66 percent of children served at elementary school
20health centers, are Latino.

21(8) School health centers support educational achievement, help
22increase attendance rates, and allow educational resources to be
23more effectively targeted toward learning.

24(9) The federal Patient Protection and Affordable Care Act
25(Public Law 111-148) contains provisions that recognize the
26importance of school health centers in the delivery of quality,
27affordable health care and that would call for their expansion.
28Under the health care reform, California is developing new
29strategies to increase access to health care and reduce health care
30costs through investing in prevention services. School health
31centers are important sites through which to increase child and
32adolescent access to health care services and early identification
33of chronic diseases, such as asthma or obesity, and high-risk
34behaviors, such as mental health disorders, substance abuse, and
35teen pregnancy, that significantly impact health care costs later in
36life.

37(10) Additionally, through education finance reform, California
38has increased accountability strategies for local educational
39agencies that highlight the need for schools to address important
40health-related indicators, such as chronic absenteeism.

P10   1(11) School-based health centers serve as an effective foundation
2upon which schools and communities can build and implement a
3community schools strategy providing a range of wrap-around
4 services to students and their families.

5(b) It is the intent of the Legislature to support existing school
6health centers and expand the number of health centers in
7California and that funds should be placed within the School-Based
8Health and Education Partnership Program, as defined under
9Article 10 (commencing with Section 124174) of Chapter 3 of
10Part 2 of Division 106 of the Health and Safety Code.



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